Lance Lunsford, MBA, FACHE’s Post

Walmart just announced big news: it is closing its medical clinics and telemedicine because it was not financially sustainable. This follows similar trends from Walgreens and others. It’s not rocket science: if we want to live long healthy lives, we need access to good medical care. Yet even large retailers can’t make it work. Here’s why we haven’t licked this as a country so far: - The bedrock of health is preventative, primary care. Some of these clinic schemes have been designed to cover urgent, sick care needs, instead of build connections with patients over years. - 15-20% of people with insurance change their health plan every year. There is little incentive for your insurance company to invest in relationships with your doctor - The big $$$ get made from the newest oncology treatment, or the expensive life-saving surgeries >>> early intervention primary care. We pay for the outcomes we want I’m an optimist, but it is getting hard to see the horizon. Where in the country are we doing primary care well? And how do we scale it? American Academy of Family Physicians American College of Physicians

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Building on my recent reporting about MA offerings, additional updates from major payers highlight further expansions and enhancements for the 2025 enrollment period: ·        UnitedHealthcare: Adding 140 plans, covering 96% of eligibles, with expanded special needs plans and various $0 copay benefits. ·        Humana: Offering 793 plans across 48 states, expanding PPO plans, and adding dental and vision benefits. ·        Aetna: Adding 76 counties, with $0 premium plans and benefits for chronic conditions and dual-eligibles. ·        Elevance Health: Expanding into 99 counties, focusing on $0 premiums, prepaid cards, and digital health programs. ·        Cigna: Reaching 29 states, adding stipends for needs like food and utilities, along with $0 premium plans. ·        WellCare: Adding Iowa while exiting other states, focusing on $0 copays and expanded benefits for groceries, utilities, and more.

Dollar General ends their mobile clinics 18 months after its launch 💲🩺 Dollar General, the nation’s largest retailer by number of locations, and DocGo, #digitalhealth provider, ended their pilot partnership to deliver #preventativecare, #urgentcare, and #chronicconditionmanagement within rural communities. They accepted Medicaid, Medicare, some commercial plans, and rates starting at $69 for those without insurance. DocGo reported positive results from the pilot and a consistent net promoter score above 90% even though the pilot ended. This is following other large retailers, like Walmart, Walgreens, and CVS Health looking to disrupt healthcare but struggling or ending their #directtoconsumer #primarycare programs. 📉 Will any large incumbent who isn’t traditionally in healthcare be able to disrupt the industry for the better? #healthcareinnovation #healthtech

The real reason Walmart and others continue to fail in primary care clinics I have read many reasons for the retail giant’s exit from the primary healthcare market. The best I’ve seen thus far from a non-clinician, is from Dr. David Dobrzykowski. https://lnkd.in/g8kC4Tiy. I follow him for good reason. Nearly every article highlights inflation, operating costs, reimbursement, insurance contracts, and obviously the foremost reason--the lack of profitability--due to the above. But there is a primary lack of understanding that the business world better learn if it doesn’t want to keep wasting money and time. Healthcare is unlike any other industry and the product that we provide is special to its human consumers. The elephant in the Walmart (and recently CVS and Walgreens) waiting room is that caring for someone’s health is far more than a consumer transaction. One commentator missed it, as many do, stating a common presumption that seems to continue to encourage this recurrent retail-into-healthcare failure: [We] “will chalk it up to another learning in the exploration of ‘can consumer focused retail orgs learn the provider game faster than providers can learn the consumer focused retail game.’" The obvious assumption is that the proper way to find success in primary care is to blend retail strengths and healthcare provider strengths. This is the primary area in which retail has been, is, and will be misguided. When the ministry of healing became the industry of modern healthcare business people assumed that they understood it, as it must be like any other business – offer a product more efficiently and at a lower cost than your competitors and you’ll succeed. Well, Walmart is better at this than brick and mortar organization in the world, yet they failed again, as they did in the early 2000s. Health care generally, and primary care very specifically, aren’t about a consumer commodity exchange. Primary care isn’t a product but a care relationship based on scientific knowledge and personal bedside manner. Until industry understands that they’re really still patients, not customers at heart, we will continue to see the same. If Walmart, CVS, Walgreens, Amazon, or General Electric for that matter, want to make money in primary health care provision, they just need to buy an entire health system, utilize primary care as the loss-leader gateway to the profitable specialties. That is the only way that it will be both profitable and caring health provision. Otherwise, this will be the industrial outcome of treating an extremely personal, emotional, and necessary human ministry like a commodity.  

Giants like Walmart initially promised to provide health care access to those who needed it most. They then realized that "the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time," so they got out. This is after investing billions. Same for Walgreens, same for CVS. https://lnkd.in/gFH4WWtQ Insurance-based primary care is not the way forward because insurance middlemen take a cut of the profits without providing any value to the patient. In fact, insurance harms the patient and hinders primary care. So why not just bypass insurance entirely? That's what we at Mila Family Health (and many others) are doing. At Mila Family Health, we provide non-insurance-based DIRECT primary care, where patients pay a low-monthly membership and get access to high quality care at a lower cost. No insurance? No problem.

Elevance Health saw other #payers getting into or expanding their #primarycare business and said 'deal me in.' In partnership with private equity firm Clayton Dubilier & Rice, the insurer has launched Mosaic Health, a primary care network that will allow Elevance to reach more patients through a similar approach as its peers. While retailers and disruptors have struggled to find their footing in primary care, payers are not backing down from investing in the space. They believe their ability to leverage their health insurance will allow them to control more of the patient journey. Mosaic will initially be comprised of CD&R’s portfolio companies, apree health and Millennium Physician Group. Elevance's Carelon Health will be added into the mix once it receives regulatory approval, which will enable the insurer to push Mosaic at the care delivery clinics. Rivals like CVS and UnitedHealth continue to invest heavily in primary care and now with Mosaic, Elevance will have a chance to compete in the space. Are payers going to find success in primary care like they're expecting? HealthLeaders

Been seeing a lot of news articles about Walmart taking a step back from the health sector. Pretty big change in trajectory after being on track to have a primary care presence in eight different states by the end of 2024. Since I did college in Northwest Arkansas at the University of Arkansas and have a lot of Walmart or Walmart-affiliated connections, would be curious to hear what people are thinking? Drop me a comment below! As we seek to understand, Walmart cites a few things as reasons why they are taking a step back and feel this may not be the right time and/or industry for their company. A spokesperson for the company shared two primary things leading them to this decision: 1) “a challenging reimbursement environment” 2) “escalating operating costs” Based on Walmart Health’s mission and clinic site locations, a third driving factor almost undoubtedly was: 3) the complexity of delivering high-quality primary care, especially in underserved communities Walmart came in as one of several big, for-profit, non-traditional disrupters to shake things up in healthcare over the past couple of years. They sought to adapt to the industry through savy for-profit methodology and resources to optimize reimbursements from insurance companies and subsequently profits, but it appears the complexity of our broken U.S. healthcare system was too much for their appetite right now. The broken system is significantly contributed to by the wildly complicated insurance-reimbursement system, which requires significant administrative staff time to navigate well. They likely also found underserved patient populations to be too sick and complex for their band-width. Walmart often cites that 90% of the U.S. population lives within 10 miles of a Walmart. When they sought to fill a hole in the community by addressing access to care needs in underserved communities, they came face-to-face with the outcomes of that disparity... very complex healthcare and social situations in their patients' lives. Patients that haven't seen a doctor or had an annual with a PCP in years to decades sometimes with a laundry list of issues needing to be addressed in 30 but more likely 15 minutes. In addition, a separate list of social determinants of health that are prohibitive to a patient's well-being. And the confluence of these two things results in high operating costs. It takes something special to put in the time, effort, and money to tackle these issues with this special patient population. While Walmart is special, looks like it wasn't the right kind of special for this tall order. See my article from last year where I discuss this from a 30,000 foot level: https://lnkd.in/gpD4vvEZ More to come soon! #Walmart #healthcare #forprofit #corporate #accesstocare #underserved #primarycare #socialdeterminantsofhealth #SDOH #clinic #disrupter

The real reason Walmart and others continue to fail in primary care clinics I have read many reasons for the retail giant’s exit from the primary healthcare market. The best I’ve seen thus far from a non-clinician, is from Dr. David Dobrzykowski. https://lnkd.in/g8kC4Tiy. I follow him for good reason. Nearly every article highlights inflation, operating costs, reimbursement, insurance contracts, and obviously the foremost reason--the lack of profitability--due to the above. But there is a primary lack of understanding that the business world better learn if it doesn’t want to keep wasting money and time. Healthcare is unlike any other industry and the product that we provide is special to its human consumers. The elephant in the Walmart (and recently CVS and Walgreens) waiting room is that caring for someone’s health is far more than a consumer transaction. One commentator missed it, as many do, stating a common presumption that seems to continue to encourage this recurrent retail-into-healthcare failure: [We] “will chalk it up to another learning in the exploration of ‘can consumer focused retail orgs learn the provider game faster than providers can learn the consumer focused retail game.’" The obvious assumption is that the proper way to find success in primary care is to blend retail strengths and healthcare provider strengths. This is the primary area in which retail has been, is, and will be misguided. When the ministry of healing became the industry of modern healthcare business people assumed that they understood it, as it must be like any other business – offer a product more efficiently and at a lower cost than your competitors and you’ll succeed. Well, Walmart is better at this than brick and mortar organization in the world, yet they failed again, as they did in the early 2000s. Health care generally, and primary care very specifically, aren’t about a consumer commodity exchange. Primary care isn’t a product but a care relationship based on scientific knowledge and personal bedside manner. Until industry understands that they’re really still patients, not customers at heart, we will continue to see the same. If Walmart, CVS, Walgreens, Amazon, or General Electric for that matter, want to make money in primary health care provision, they just need to buy an entire health system, utilize primary care as the loss-leader gateway to the profitable specialties. That is the only way that it will be both profitable and caring health provision. Otherwise, this will be the industrial outcome of treating an extremely personal, emotional, and necessary human ministry like a commodity.